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We determined the demographic, health, functional, and satisfaction factors related to lower-limb prosthesis or wheelchair use among veterans with lower-limb amputation. Forty-two veterans were recruited from the 20th National Disabled Veterans Winter Sports Clinic and the 26th National Veterans Wheelchair Games. Participants were at least 18 years of age, had a lower-limb amputation, and were either prosthesis or wheelchair users. Level of amputation was the most significant health-related characteristic determining the veterans' use of a prosthesis versus a wheelchair (p = 0.02). Veterans who had a higher level of amputation and used a prosthesis reported significantly greater difficulty navigating a ramp (p = 0.03), getting in and out of cars and buses (p = 0.03), carrying 10 lb of groceries (p = 0.02), and participating in sports and leisure activities (p = 0.03). The parameter "satisfaction related to prosthesis" did not determine selection of mobility device type. The interaction of demographics, health-related characteristics, and mobility device characteristics affects functional performance and influences the use of prostheses, wheelchairs, or both in persons with lower-limb amputation. Long-term outcome assessments may help determine factors associated with either transition from one device to another or combined use of the devices over time.

Objective: To investigate relationships between carpal tunnel syndrome, functional status, subject demographics, physical examination findings, and median nerve conduction study findings in manual wheelchair users with paraplegia. Design: Multicenter cross-sectional study. One hundred twenty-six manual wheelchair-using individuals with chronic paraplegia answered self-administered questionnaires on demographics, symptoms, and functional status. They underwent physical examination specific for carpal tunnel syndrome and upper-limb nerve conduction studies. Results: Fifty-seven percent of subjects had symptoms (72.2% bilateral); hand numbness was most common. Sixty percent of subjects had carpal tunnel syndrome physical examination findings (59.2% bilateral). Those with physical examination findings were more likely to have longer duration of injury (P = 0.003). Seventy-eight percent of subjects had electrophysiologic evidence of median mononeuropathy. Symptomatic subjects had significantly greater median-ulnar motor latency difference in the dominant hand (P = 0.02) and smaller compound muscle action potential amplitudes bilaterally (dominant hand, P = 0.01; nondominant hand, P = 0.04). Persons with carpal tunnel syndrome symptoms and physical examination findings had significantly worse functional status (symptoms, P < 0.001; physical examination, P = 0.02) and symptom severity scores (symptoms, P < 0.001; physical examination, P = 0.01), but a similar difference between subjects with and without median mononeuropathy was not seen. Logistic regression analysis revealed that the presence of symptoms was predicted by median-ulnar motor latency difference in the dominant hand (odds ratio, 4.38; 95% confidence interval 1.72-11.14) and sensory nerve action potential amplitude in the nondominant hand (odds ratio, 0.97; 95% confidence interval, 0.94-0.99). ConclusionS: The interaction among symptoms, physical examination, and nerve conduction study findings is complex. Car

Purpose. The purpose of this study was to determine the characteristics of individuals who participa e in the National Veterans Wheelchair Games (NVWG) and the Winter Sports Clinic (WSC) for veterans with disabilities. In addition, it was of interest to determine how these events had impacted their lives. Method. Participants were recruited atthe 20th Winter Sports Clinic, held in Snowmass Colorado and the 26th National Veterans Wheelchair Games held in Anchorage, Alaska. Data of interest included demographic, sport participation information, community integration, self-esteem, and quality of life. A secondary data analysis was completed to determine how comparable individuals who attended the NVWG/WSC were to individuals who did not participate in these events. Results. The 132 participants were a mean age of 47.4 + 13.4 and lived with a disability for an average of 13.4 + 12.1. Participants felt that the NVWG/WSC increased their knowledge of sports equipment (92%), learning sports (89%), mobility skills (84%), and acceptance of disability (84%). The majority of participants stated that the NVWG/WSC improved their life. Of those who participated at the NVWG/WSC, they tended to be more mobile, but have increased physical and cognitive limitations as measured by the CHART when compared to the non-attendees. Conclusions. Recommending veterans participate in events such as the NVWG and WSC can provide psychosocial benefits to veterans with disabilities.

The purpose of this study was to develop the scoring system for the Seating and Mobility Script Concordance Test (SMSCT), obtain and appraise internal and external structure evidence, and assess the validity of the SMSCT. The SMSCT purpose is to provide a method for testing knowledge of seating and mobility prescription. A sample of 106 therapists and 15 spinal cord injury experts contributed to the development of the scoring system. Validity evidence was obtained using 15 seating and mobility experts, 10 orthopedic experts, and 66 therapists with varying levels of seating and mobility expertise. Proxy measures of clinical expertise were used for external validity evidence since no criterion measures exist. The SMSCT was found to differentiate between seating and mobility experts' and orthopedic experts' intervention subtest scores (p = 0.04). The proxy measure of clinical expertise, seating and mobility hours/week, was found to predict SMSCT intervention scores (p = 0.002). The internal structure of the SMSCT may include evidence of reduced item performance but satisfactory convergent and discriminate evidence by construct definition. Although the SMSCT may be a promising approach for measuring seating and mobility expertise, limitations exist in the corrected content. Future application of the SMSCT should only be used after further development of the tool occurs. Copyright © 2009 RESNA.

This study examined the usage of powered seating functions, including tilt-in-space, backrest recline, and seat elevation, among a group of wheelchair users during their typical daily activities. Twelve individuals who used a power wheelchair with seating functions participated in the study. They drove their own wheelchair and used the seating functions as needed in their community environment for about 2 weeks while the seating function usage was recorded with a portable device. We found that subjects occupied their wheelchair for 11.8 +/- 3.4 hours a day (all data shown as mean +/- standard deviation). While occupying their wheelchairs, they accessed tilt-in-space, backrest recline, and seat elevation 19 +/- 14 times a day for 64.1% +/- 36.8%, 12 +/- 8 times for 76.0% +/- 29.8%, and 4 +/- 4 times for 22.5% +/- 34.9%, respectively. Subjects chose to stay in tilted and reclined positions in their wheelchair for 39.3% +/- 36.5% of their time each day. They spent little time in a fully upright position. Subjects changed their seating positions every 53.6 +/- 47.0 minutes. Time spent in positions of different seating pressures varied among subjects. The information collected could enhance clinical practice of wheelchair provision, resulting in better compliance with clinical instructions and appropriate use of seating functions among wheelchair users.

Objectives: This preliminary study was to evaluate the impact of pushrim-activated power-assist wheelchairs (PAPAWs) on mobility, community participation, satisfaction, and psychosocial impact among individuals with tetraplegia. Design: Frfteen manual wheelchair users with tetraplegia completed a 4-wk protocol including a 2-wk trial where they used their personal wheelchairs for mobility and a 2-wk trial where they were provided with a PAPAW and could choose either wheelchair for mobility. The mobility levels with both wheelchairs were recorded by a datalogger. Participants completed dairy questionnaires regarding community participation and their satisfaction with the wheelchair used. The Psychosocial Impact of Assistive Devices Scale was used to compare the psychosocial impact of PAPAWs with their personal wheelchairs. Results: Participants chose to use PAPAWs and their personal wheelchairs at a similar frequency in the PAPAW trial. The distances traveled with both wheelchairs were not statistically different (P = 0.09). Participants traveled significantly faster with PAPAWs (P = 0.03). PAPAWs did not result in significantly greater community participation, satisfaction, and psychosocial impacts than the personal wheelchairs. Conclusions: PAPAWs could be a viable mobility option for individuals with tetraplegia, which can provide independent mobility especially for outdoor activities. A user's preference, life style, physical conditions, transportation issues, and environmental factors should be considered in prescribing such a device. Copyright © 2008 by Lippincott Williams & Wilkins.

Manual wheelchair users are subjected to wholebody vibrations (WBV) on a regular basis as they traverse obstacles and uneven surfaces. One way users could protect themselves from secondary injuries related to WBV is by using a suspension manual wheelchair. This study investigated the ability of suspension manual wheelchairs to reduce seat accelerations during curb descents of various heights (5, 10, and 15 cm). Sixteen manual wheelchairs (four suspension, four folding, four rigid, and four rigid titanium) were tested. Suspension wheelchairs transmitted significantly lower peak seat accelerations than folding wheelchairs during the 5 cm curb descents (p = 0.048) and significantly lower frequencyweighted peak seat accelerations during the 5 and 10 cm curb descents (p = 0.03 for both heights). However, when the suspension wheelchair Quickie XTR (Sunrise Medical; Carlsbad, California) was removed from the analysis, the suspension wheelchairs were not significantly different from the nonsuspension wheelchairs. When weight was considered, the suspension wheelchairs had significantly lower peak seat accelerations than the lighter rigid wheelchairs during 5 cm curb descents (p = 0.047). While suspension manual wheelchairs offer some reduction in WBV during curb descents, their limitations should be considered when a wheelchair is selected for everyday use.

Acute mountain sickness (AMS) is a frequent complication for military personnel, veterans, athletes, and travelers at high altitudes. Symptoms may occur in individuals with less cerebrospinal fluid volume and less ability to accommodate increased brain volume. No studies on AMS exist in individuals with neurological impairments. We studied 64 subjects, including active and sedentary controls and those with tetraplegia, paraplegia, multiple sclerosis, and traumatic brain injury at the 2007 National Veterans Winter Sports Clinic in Snowmass, Colorado. Subjects completed three Lake Louise Score surveys to quantify symptoms. We found a higher than expected occurrence of AMS overall (51.6%) but no differences among groups, and few participants sought treatment. Fatigue and weakness were common symptoms. High subject activity levels may explain these findings. More research is warranted on larger sample sizes and on preventative medications and treatments for AMS, especially since many military personnel with neurological impairments are returning to full active service.

This paper provides an overview of the development of a wheelchair users registry and subsequently describes a population of individuals who use wheelchairs. The characteristics of Americans who permanently use wheelchairs and scooters are currently unknown. As the result of developing a Registry of individuals who use wheeled mobility devices for systematic recruitment for research studies, this study provides a description of a nationwide sample of over 1000 individuals who used wheelchairs or scooters for their daily mobility. The Registry is predominantly Caucasian (83%), 63% male, with a mean age of 50 years. Some 54% used manual wheelchairs for an average of 16 years. When quality of wheelchairs was compared, results indicated those in more customizable manual wheelchairs were significantly more likely to be younger. Males were significantly more likely to receive more customizable, heavy duty power wheelchairs than females. The Wheelchair Users Registry provides an organized and systematic way to maintain contact with previous research participants. Expected to grow in size, the Registry may enable an even more diverse pool of subjects interested in participating in research studies. © 2007 Informa UK Ltd All rights reserved.

Although engaging in an active lifestyle is beneficial for maintaining quality of life, a majority of wheelchair users are inactive. This study investigated the mobility characteristics and activity levels of manual wheelchair users in the residential setting and at the National Veterans Wheelchair Games (NVWG). Demographic factors that may have influenced activity in the home environment were also identified. Fifty-two manual wheelchair users completed a brief survey, and their activity was monitored with a custom data logger over a period of 13 or 20 days. We found that they traveled a mean +/- standard deviation of 2,457.0 +/- 1,195.7 m/d at a speed of 0.79 +/- 0.19 m/s for 8.3 +/- 3.3 h/d while using their primary wheelchair in the home environment. No significant differences in mobility characteristics or activity levels were found for level of spinal cord injury or disability. We also found that subjects traveled significantly farther and faster and were active for more hours during an average day at the NVWG than in the home environment (p < 0.001). We found that manual wheelchair users who were employed covered more distance, accumulated more minutes, and traveled a greater average maximum distance between consecutive stops than those who were unemployed. Results from this study provide a better understanding of the activity levels achieved by manual wheelchair users and insight into factors that may influence this activity.

Wheelchair users rely on their wheelchairs for mobility for extended periods of time every day. According to the International Standards Organization 2631-1 standard on human vibration, individuals in a seated position when exposed to whole-body vibrations (WBV) are at risk of injury. This study evaluated vibration exposure during manual and power wheelchair driving over nine sidewalk surfaces and differences in vibration exposure over 3 years. Ten nondisabled subjects were asked to drive a manual wheelchair at 1 m/s and a power wheelchair at 1 m/s and 2 m/s over nine sidewalk surfaces while WBV were measured at the seat and footrest of the wheelchair. At 1 m/s, significant differences existed between surfaces and years at both the seat and the footrest for the manual and power wheelchair users. At 2 m/s, significant differences existed between surfaces and years at the seat and the footrest for power wheelchair users. Our results show that both manual and power wheelchair users may be at risk for secondary injuries from WBV when traveling over certain surfaces.

During fiscal years 2000 and 2001, the Veterans Health Administration provided veterans with more than 131,000 wheelchairs and scooters at a cost of $109 million. This national study is the first to investigate Veterans Health Administration costs in providing wheelchairs and scooters and to compare regional prescription patterns. With a retrospective design, we used descriptive methods to analyze fiscal years 2000 and 2001 National Prosthetics Patient Database data (cleaned data set of 113,724 records). Wheelchairs were categorized by function, weight, and adjustability options for meeting individual needs (e.g., axle position, camber, position of wheels, tilt, and recline options). Results displayed a cost distribution that was negatively skewed by low-cost accessories coded as wheelchairs. Of the standard manual wheelchairs, 3.5% could be considered beyond the customary cost. Regionally, 71% to 86% of all wheelchairs provided were manual wheelchairs, 5% to 11% were power wheelchairs, and 5% to 20% were scooters. The considerable variation found in the types of wheelchairs and scooters provided across Veterans Integrated Service Networks may indicate a need for evidence-based prescription guidelines and clinician training in wheeled-mobility technologies.

Innovations to control interfaces for electric powered wheelchairs (EPWs) could benefit 220 000 current users and over 125 000 individuals who desire mobility but cannot use a conventional motion sensing joystick (MSJ). We developed a digital isometric joystick (IJ) with sophisticated signal processing and two control functions. In a prior study, subjects' driving accuracy with our IJ was comparable to using an MSJ. However, we observed subjects using excessive force on the IJ possibly because its rigid post provides no positional feedback. Thus, this paper examines the time-series data recorded in the previous study to characterize subjects' force control strategies since weakness is a concern. Eleven EPW users with upper limb impairments drove an EPW using an IJ with two different control functions and an MSJ in a Fitts' law paradigm. Subjects relied upon positional feedback from the MSJ and used appropriate force. In contrast, subjects using the IJ with either control function applied significantly higher force than necessary (p< 0.0001 and p=0.0058). Using higher average force was correlated with quicker trial times but not associated with accuracy. Lack of positional feedback may result in use of excess isometric force. Modifying control functions, adjusting gain, or providing additional training or feedback might address this problem. © 2007 IEEE.

Individuals with multiple sclerosis (MS) report decreased satisfaction with their mobility devices compared with individuals with spinal cord injuries (SCIs). This study (1) investigated the demographic differences between veterans with MS (V-MS) and veterans with SCI (V-SCI) who were issued a wheelchair by the Veterans Health Administration (VHA) and (2) described differences in mobility device prescription. We merged two VHA databases to obtain demographic and wheelchair information for all V-MS and V-SCI in 2000 and 2001. Descriptive information for issued wheelchairs was available for 2,154 V-MS and V-SCI. We found that V-MS were significantly less likely to receive higher quality wheelchairs (manual or power) compared with V-SCI (p < 0.001). The disparity in VHA wheelchair prescription between these two groups indicates a need for further research regarding the assistive device prescription process in these populations.

Purpose. Training of appropriate wheelchair propulsion methods may be beneficial to the individual who uses a wheelchair by reducing the incidence of pain and improving one's quality of life. This paper discusses the development and initial testing of a training device that was developed to aid in wheelchair propulsion techniques: GAMEWheels System. Methods. Two separate models of GAMEWheels have been developed: a GAMEWheels Clinical and a GAMEWheels Trainer. Details of the development process and the refinement have been included in this manuscript. To verify and compare the practicality and functionality of the two GAMEWheels systems, several focus groups were conducted: first to determine whether the systems could be set-up with informational materials and second to determine if the systems could be taught to novice users. Results. Results from the focus group indicate that the overall impressions of the systems were that they were fun to play. Suggestions were raised to improve the design, which have been incorporated into further refinement of the GAMEWheels systems. Conclusions. This paper provides an overview of the development of a wheelchair-training device. Valuable information was gained to improve the design of the GAMEWheels systems. © 2006 Informa UK Ltd All rights reserved.

Increased physical activity is important for reducing the risk of cardiovascular disease. However, among people with disabilities, inactivity is prevalent. In order to encourage exercise among members of this group, an exercise system combining arm ergometry with video gaming, called the GAME Cycle was previously developed. User input was received through an arm crank ergometer on a swivel, with the angular velocity of the ergometer resistance wheel controlling one axis and rotation of ergometer about the swivel controlling the other. The purpose of this study was to detail the algorithms used in this device and present novel features included in a second generation of the GAMECycle. The features include a wheel on base, a steering return mechanism, and wireless fire buttons. A focus group of clinicians (n = 8), wheelchair users (n = 8), and clinician wheelchair users (n = 2) was conducted to evaluate the features of the GAMECycle. The focus group suggested improvements to the steering mechanism and to reduce vibration in the system. However, the focus group enjoyed the GAMECycle and felt that it would encourage exercise among persons with disabilities. © 2006 IEEE.

Little is known about the reasoning process clinicians use when prescribing wheeled mobility equipment (WME) or about the outcomes of this process, i.e., how many devices are prescribed, to whom, how often, and at what cost. This study characterized veterans who received WME from the Veterans Health Administration. We analyzed variance in wheelchair provision based on sex, race/ethnicity, diagnosis, and age. Three years of data from the National Prosthetics Patient Database and the National Patient Care Database were merged, yielding more than 77,000 observations per fiscal year. Logistic regression analysis revealed associations between WME provision and age, sex, and race/ethnicity, when analysis was controlled for diagnosis and number of comorbidities. Hispanics (odds ratio [OR] = 1.864), African Americans (OR = 1.360), and American Indians/Asians (OR = 1.585) were more likely than Caucasians to receive standard wheelchairs. Hispanics (OR = 0.4), African Americans (OR = 0.7), and American Indians/Asians (OR = 0.4) were less likely than Caucasians to receive scooters.

With about 2.2 million Americans currently using wheeled mobility devices, wheelchairs are frequently provided to people with impaired mobility to provide accessibility to the community. Individuals with spinal cord injuries, arthritis, balance disorders, and other conditions or diseases are typical users of wheelchairs. However, secondary injuries and wheelchair-related accidents are risks introduced by wheelchairs. Research is underway to advance wheelchair design to prevent or accommodate secondary injuries related to propulsion and transfer biomechanics, while improving safe, functional performance and accessibility to the community. This paper summarizes research and development underway aimed at enhancing safety and optimizing wheelchair design. © 2006 IEEE.

OBJECTIVE: An estimated 125,000 Americans with movement disorders that preclude independent mobility in a power wheelchair could benefit from improved control devices. We developed variable gain algorithm (VGA) software for our isometric joystick (IJ) that allows it to emulate a commercially available motion-sensing joystick (MSJ) in performance but retain the unique customizable features of an isometric control. Force sensing algorithm (FSA) software allowed the IJ to function as a simple isometric device. DESIGN: Using a Fitts' Law paradigm, we compared driving performance with floor targets using a standard MSJ and an IJ with both FSA and VGA software in 11 electric power wheelchair users with a variety of impairments. Outcome measures were reaction time (RT), movement time (MT), and driving accuracy (DA). RESULTS: The IJ with FSA had a significantly shorter RT than the MSJ (P < 0.0020). The IJ with FSA had a significantly longer MT than the MSJ to far targets (P < 0.0159). No differences were found between the IJ with VGA and the MSJ with respect to RT or MT. No differences in DA were found among any of the joysticks. CONCLUSIONS: VGA software allowed the IJ to function similarly to the MSJ with respect to RT, MT, and DA. Copyright © 2006 by Lippincott Williams & Wilkins.

Purpose. This cross-sectional study examined whether partnering with service dogs influenced psychosocial well-being and community participation of adult individuals using wheelchairs or scooters. Method. One hundred and fifty-two people were recruited and group-matched, resulting in 76 participants with and 76 without service dogs. Standardized scale scores for affect, depressive symptoms, self-esteem, and loneliness were used to operationally define psychosocial well-being. Community participation was assessed with the Social Integration domain of the Craig Handicap Assessment and Reporting Technique. Results. Psychosocial characteristics did not differ significantly between those partnered with and without service dogs overall. However, of participants with progressive conditions, those with service dogs demonstrated significantly higher positive affect scores than comparison group participants. Among those with clinical depression, service dog partners scored significantly higher in positive affect. Finally, regardless of whether individuals had service dogs, fewer depressive symptoms and being female or married were predictors of greater community participation. Conclusion. Select individuals may experience psychosocial benefits from partnering with service dogs. However, it is unclear if these benefits might also be derived from companion dogs. Further research is needed to substantiate the findings of this study. © 2006 Informa UK Ltd All rights reserved.

Introduction: Manual wheelchair users have been found to be at risk for secondary upper extremity injuries. Purpose: The primary goal of this study was to compare shoulder strength and muscle imbalance of individuals with paraplegia to case-wise matched unimpaired controls (UC). A secondary goal was to evaluate the impact of age and neurologic level of injury (NLI) on weight-normalized strength (WNS). Methods: The SCI group (n = 28) and the UC group (n = 28) completed bilateral shoulder isokinetic strength testing in the sagittal, frontal, and horizontal plane at 60 degrees/second using the BioDex system. Strength ratios, an indicator of muscle imbalance, were also calculated. Results: No significant difference was seen in shoulder strength or strength ratios between the SCI group and the UC group. However, NLI was significantly related to WNS on several planes in the SCI group. Therefore, we dichotomized the SCI group into equal groups based on an NLI. The Low-SCI group was significantly stronger than the High-SCI group in most planes (P < 0.05). The High-SCI group was significantly weaker than the UC in extension (P < 0.01) and a trend (P < 0.01) was seen in flexion, abduction, and external rotation. The Low-SCI group was significantly stronger in abduction than the UC. Conclusion: WNS at the shoulder correlated with NLI. It is likely that this is related to contributions of the trunk and abdominal muscles during testing, since proximal trunk strength aids in generating forces distally. This study and others of strength in individuals with paraplegia may overestimate shoulder strength.

Some aspects of assistive technology can be enhanced by the application of virtual reality. Although virtual simulation offers a range of new possibilities learning to navigate in a virtual environment is not equivalent to learning to navigate in the real world. Therefore, virtual reality simulation is advocated as a useful preparation for assessment and training within the physical environment. We are engaged in several efforts to develop virtual environments and devices for mobility skills assessment and training, exercise training, and environment assessment. Virtual reality offers wheelchair users a training tool in different risk-free environments without any indoor (e.g., walls, furniture, and stairs) and outdoor (e.g., curb cuts, uneven terrain, and street traffic) physical constraints. Virtual reality technology will probably become more common in the field of assistive technology, especially given the rapid expansion of gaming technology and the continued exponential growth of computing power. © 2005 Taylor & Francis Group, LLC.

In this pilot study, we assessed wheelchair durability and its effect on user satisfaction. Specifically, we examined the characteristics of the participants' wheelchairs, the types of maintenance and repairs completed, and whether the participants' satisfaction was affected by problems with their wheelchairs. A convenience sample of 130 participants who used wheelchairs as their primary means of mobility was recruited. Participants completed a questionnaire about their wheelchairs, the maintenance and repair history, and their satisfaction levels. Results showed that 26% of the participants had completed a wheelchair repair in the past 6 months, 16% had completed general maintenance, and 27% had completed tire repairs. Neither hours of wheelchair use nor wheelchair age affected repair or maintenance frequency. Participants were generally satisfied with their wheelchairs. Better understanding of wheelchair maintenance and repair issues will guide improvements in wheelchair design and enhance the community participation of individuals who use wheelchairs.

Objectives To evaluate the durability and value of 3 common suspension manual wheelchairs and to compare the results with those of previously tested lightweight and ultra-lightweight folding-frame wheelchairs. Design Standardized fatigue testing and cost analysis of 3 suspension manual wheelchairs from 3 different manufacturers. Setting A rehabilitation engineering center. Specimens Nine suspension manual wheelchairs. Interventions Wheelchairs were fitted with a standardized wheelchair test dummy and tested on a series of fatigue tests, consistent with those developed by the International Organization for Standardization. Main outcome measures Fatigue life (measured as the number of equivalent cycles completed) and value (equivalent cycles divided by cost) were compared among all wheelchairs. Results Analysis of variance revealed significant differences (P≤.05) in the number of equivalent cycles among the suspension wheelchairs tested. When compared with previously tested ultra-lightweight and lightweight wheelchairs, the suspension wheelchairs failed to show significant improvements; however, significant improvements were found between individual suspension and lightweight wheelchairs. Conclusions We found little evidence to suggest that suspension manual wheelchairs provide advantages in terms of durability or value over standard lightweight and ultra-lightweight folding-frame wheelchairs. © 2005 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

According to the International Standards Organization 2631-1 standard on human vibration, individuals in a seated position are at risk of injury due to whole-body vibrations when exposed for long periods of time. Wheelchair users fit this description perfectly; however, little research has been conducted to evaluate the amount of vibration transmitted to a wheelchair user. The vibration exposure produced by traversing nine surfaces was evaluated by having 10 individuals without disabilities propel over them in both a manual wheelchair at 1 m/s and a powered wheelchair at 1 and 2 m/s. Root-mean squared (RMS) vertical vibration was examined to determine if differences existed between surfaces. At 1 m/s for both the manual and the powered wheelchair the 8-mm bevel interlocking concrete surface produced significantly higher RMS vertical vibration than the other surfaces. At 2 m/s in the powered wheelchair, the poured concrete surface (control) produced the significantly highest RMS vertical vibration. Based on the manual and power wheelchair results of this study, use of selected ICPI pavers would be acceptable for any route traveled by individuals using wheelchair. Furthermore, a 90° herringbone pattern is preferred over the 45° pattern, and it is recommended that for safety reasons regarding vibration exposure a bevel of less than 6 mm should be used. © 2005 Taylor & Francis.

Objectives: To test the differences between a pushrim-activated power-assisted wheelchair (PAPAW) and a traditional manual wheelchair while performing common driving activities and to assess their relative merits for people with tetraplegia. Design: Repeated measures. Setting: An activities of daily living (ADL) laboratory within a rehabilitation research center. Participants: Fifteen full-time manual wheelchair users with tetraplegia due to a spinal cord injury. Interventions: Participants propelled both their own manual wheelchairs and a PAPAW 3 times over an ADL course. The order in which the 2 different wheelchairs were presented to the participants was randomized. Main Outcome Measures: Each participant's heart rate was monitored throughout testing by a digital, wireless heart-rate monitor. Time to complete the course was recorded, and participants were surveyed with a visual analog scale after the first, third, fourth, and sixth trials to determine the ease of completing each obstacle and their ergonomic preferences between the 2 wheelchairs. Participants also were observed throughout the trials to determine how much assistance they needed to complete each obstacle course. Results: After using a Bonferroni adjustment, 4 obstacles (carpet, dimple strips, up a ramp, up a curb cut) were rated as being significantly easier (P<.001) to complete when using the PAPAW. Participants also showed a significant decrease in mean heart rate throughout all 3 trials (P=.015, P=.001, P=.003, respectively) when using a PAPAW. The amount of assistance needed by participants, the responses to ergonomic questions, and the overall time to complete the ADL course did not differ significantly between the 2 wheelchairs. Conclusions: For subjects with tetraplegia, PAPAWs have the potential to improve functional capabilities during certain ADLs, especially when propelling up ramps, over uneven surfaces, and over thick carpet. © 2005 by American Congress of Rehabilitation Medicine and th

Background/Objective: Previous investigations have identified muscular imbalance in the shoulder as a source of pain and injury in manual wheelchair users. Our aim was to determine whether a correlation exists between strength and pushrim biomechanical variables including: tangential (motive) force (Ft), radial force (Fr), axial force (Fz), total (resultant) force (FR), fraction of effective force (FEF), and cadence. Methods: Peak isokinetic shoulder strength (flexion [FLX], extension [EXT], abduction [ABD], adduction [ADD], internal rotation [IR], and external rotation [ER]) was tested in 22 manual wheelchair users with a BioDex system for 5 repetitions at 60°/s. Subjects then propelled their own manual wheelchair at 2 speeds, 0.9 m/s (2 mph) and 1.8 m/s (4 mph), for 20 seconds, during which kinematic (OPTOTRAK) and kinetic (SMARTWHEEL) data were collected. Peak isokinetic forces in the cardinal planes were correlated with pushrim biomechanical variables. Results: All peak torque strength variables correlated significantly (P ≤ 0.05) with Ft, Fr, and FR, but were not significantly correlated with Fz, FEF, or cadence. Finally, there were no relationships found between muscle strength ratios (for example, FLX/EXT) and Ft, Fr, FR, Fz, or FEF. Conclusion: There was a correlation between strength and force imparted to the pushrim among wheelchair users; however, there was no correlation found in wheelchair propulsion or muscle imbalance. Clinicians should be aware of this, and approach strength training and training in wheelchair propulsion techniques separately.

Fay BT, Boninger ML, Fitzgerald SG, Souza AL, Cooper RA, Koontz AM. Manual wheelchair pushrim dynamics in people with multiple sclerosis. Arch Phys Med Rehabil 2004;85:935-42. Objectives To define differences in pushrim dynamics during manual wheelchair propulsion by users with multiple sclerosis (MS) relative to 2 control groups of subjects with spinal cord injury (SCI) and no disability (ND) and to investigate changes in propulsion biomechanics at different speeds and with fatigue. Design Case-control. Setting Biomechanics laboratory. Participants A convenience sample of 42 people, 8 women and 6 men per group. Interventions Not applicable. Main outcome measures The propulsion pattern, mean maximum speed, percentage of time in push and recovery phases, push angle, push frequency, mean maximum resultant pushrim force, mean work and push cycle, and hand-to-pushrim coupling and decoupling effects. Results The MS groups tended to use an arcing propulsion pattern more than did the control groups (Pmax=.003). The MS group pushed at a lower mean maximum velocity (v) when allowed to choose the speed of propulsion (vMS, .67±.20m/s; vSCI, 1.10±0.23m/s; P=.001), when asked to push at 1m/s (vMS, .91±.26m/s; vSCI, 1.12±0.11m/s; vND, 1.05±0.13m/s; P=.010), and were unable to maintain a self-selected speed during a 5-minute trial (Δv MS, .15±.02m/s; ΔvND, .03±.06m/s; P<.001). The MS group spent a higher proportion of time in the push phase of propulsion (Pmax=.001). In general, the MS group had smaller push angles, but push frequencies similar to the controls. Statistically adjusted MS group pushrim forces and work per push measures varied depending on context, but in all trials the MS group displayed a braking effect when grasping and releasing the pushrim. The MS group had declines in most measures when pushing at a self-selected speed for 5 minutes. In all trials, the MS group was more likely to display asymmetry between right and left sides in biomechanic parameters. Conclusi

BACKGROUND: It is well established that physical activity is beneficial to health. For the individual in a wheelchair, a regular exercise program might not be available or may be too difficult to participate in physically and/or psychologically. Many exercise devices and regimes are boring. The goal, therefore, is to develop a device that makes exercise more exciting and, thus, motivates a person to exercise more or for a longer period of time, yielding increased energy expenditure. Our laboratory developed an interface between an arm ergometer and a computer game that allows the user to control game play on the screen as if using a joystick. The purpose of this study was to determine (a) whether the GAME(Cycle) system would elicit an exercise effect similar to arm ergometry, (b) whether perceived exertion would be different between the 2 devices, and (c) individuals' impressions regarding the GAME(Cycle) system. METHODS: Thirteen individuals who used wheelchairs participated in the study. Participants were asked to exercise for 2 separate, 19-minute sessions. For 1 session, a GAME(Cycle) system was used and for the other session, the same arm ergometer was used, but without the computer game being played. Physiologic data and perceived exertion were collected for each session. RESULTS: There were significant differences between playing the game and not playing the game for VO2 (P = 0.03) and VCO2 (P = 0.02), with higher values being found when the game was played. Perceived exertion was not significantly different between the 2 trials. CONCLUSION: GAME(Cycle) appears to be similar in nature with respect to energy expenditure to arm ergometry. Because this study was conducted on athletes, further research is needed with sedentary individuals to determine exercise effects and perceived exertion.

Rentschler AJ, Cooper RA, Fitzgerald SG, Boninger ML, Guo S, Ammer WA, Vitek M, Algood D. Evaluation of selected electric-powered wheelchairs using the ANSI/RESNA standards. Arch Phys Med Rehabil 2004;85:611-9. Objectives To compare the performance characteristics of different electric-powered wheelchairs (EPWs) and to evaluate the effectiveness of the American National Standards Institute/Rehabilitation Engineering and Assistive Technology Society of North America (ANSI/RESNA) wheelchair standards. Design Five types of EPWs were selected. Three wheelchairs of each type were tested according to the ANSI/RESNA wheelchair standards. Setting Rehabilitation engineering center. Specimens Fifteen wheelchairs. Interventions Not applicable. Main outcome measures Static tipping angle; dynamic tipping score; braking distance; energy consumption; static, impact, and fatigue strength; and climatic conditioning. Results There were significant differences (P<.05) among the 5 types of EPWs for static stability when facing both uphill and downhill in the most-stable and least-stable configurations. There were significant differences (P<.05) among the EPWs on most of the dynamic stability tests. There were also significant differences (P<.05) among EPWs for all the effectiveness of brakes conditions, as well as between 2 wheelchairs for the energy consumption testing. There were several failures among the wheelchairs during the static, impact, and fatigue strength testing and during the climatic testing. Conclusions The results show that EPWs can vary greatly with respect to static and dynamic stability, braking distance, range, strength testing, and climatic conditioning. All these factors have a substantial effect on safety and performance. © 2004 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

The INDEPENDENCE™ 3000 IBOT™ Transporter (IBOT™) is an electronically stabilizing device for people with disabilities. The purpose of this study was to collect qualitative data on the potential for the IBOT™ to improve employment satisfaction of veterans who use wheelchairs to work. This study was based upon observations by trained clinicians, and responses to a survey completed by four men with traumatic spinal cord injury, who worked in an office environment. The mean age of the subjects was 52 ± 8.8 years. The subjects used the devices to hold eye-level discussions with colleagues, climb stairs, ascend steep ramps, and negotiate curbs. When subjects were asked to rate the ease of getting around in the IBOT™ compared to their personal wheelchairs, they responded with a mean of 6.7 ± 1.8 on a 10-point visual analog scale. The response to rating the overall function of the IBOTTM within their working environment yielded a rating of 6.0 ± 2.8. Half of the users felt that the IBOT™ would help them at work and all thought it should be made available to veterans who use wheelchairs. A larger study should be conducted to determine if the IBOT™ affects work performance and the ability to return to work.

Fass MV, Cooper RA, Fitzgerald SG, Schmeler M, Boninger ML, Algood SD, Ammer WA, Rentschler AJ, Duncan J. Durability, value, and reliability of selected electric powered wheelchairs. Arch Phys Med Rehabil 2004;85:805-14. Objective To compare the durability, value, and reliability of selected electric powered wheelchairs (EPWs), purchased in 1998. Design Engineering standards tests of quality and performance. Setting A rehabilitation engineering center. Specimens Fifteen EPWs: 3 each of the Jazzy, Quickie, Lancer, Arrow, and Chairman models. Interventions Not applicable. Main outcome measures Wheelchairs were evaluated for durability (lifespan), value (durability, cost), and reliability (rate of repairs) using 2-drum and curb-drop machines in accordance with the standards of the American National Standards Institute and Rehabilitation Engineering and Assistive Technology Society of North America. Results The 5 brands differed significantly (P≤.05) in durability, value, and reliability, except in terms of reliability of supplier repairs. The Arrow had the highest durability, value, and reliability in terms of the number of consumer failures, supplier failures, repairs, failures, consumer repairs and failures, and supplier repairs and failures. The Lancer had the poorest durability and reliability, and the Chairman had the lowest value. K0014 wheelchairs (Arrow, Permobil) were significantly more durable than K0011 wheelchairs (Jazzy, Quickie, Lancer). No significant differences in durability with respect to rear-wheel-drive (Arrow, Lancer, Quickie), mid-wheel-drive (Jazzy), or front-wheel-drive (Chairman) wheelchairs were found. Conclusions The Arrow consistently outperformed the other wheelchairs in nearly every area studied, and K0014 wheelchairs were more durable than K0011 wheelchairs. These results can be used as an objective comparison guide for clinicians and consumers, as long as they are used in conjunction with other important selection criteria. Manufacturer

BACKGROUND: Obstacles such as bumps, curb descents, and uneven driving surfaces cause vibrations that affect the wheelchair, and in turn, the wheelchair user. Chronic exposure can cause low-back pain, disk degeneration, and other harmful effects. Little research has been conducted to assess the vibrations experienced by wheelchair users. OBJECTIVE: The purpose of this study was to conduct an evaluation of the vibration exposure during electric-powered wheelchair driving and mechanical energy requirements for manual wheelchair propulsion over selected sidewalk surfaces. The goal was to determine the criteria for a wheelchair-pedestrian access route that does not require excessive propulsive work or expose wheelchair users to potentially harmful vibrations. METHODS: Ten unimpaired individuals participated in this study. Six sidewalk surfaces were tested. Measured variables included power of the acceleration per octave, mechanical work to propel over surfaces, peak acceleration, and frequency at which peak acceleration occurs. RESULTS: For both the manual and electric-powered wheelchair, at 1 m/s, significant differences were found in peak accelerations between the seat and footrest (P < 0.0001) and between the sidewalk surfaces (P = 0.004). The greatest risk for injury caused by shock and vibration exposure occurs at frequencies near the natural frequency of seated humans (4-15 Hz). The values for work required to propel over the surfaces tested were not statistically significantly different. Besides appearance and construction, the only distinguishing characteristic was surface roughness caused by the joints. CONCLUSION: When treating the poured concrete sidewalk as the standard, surfaces 2, 3, 5, and 6 compared most favorably in terms of vibration exposure, whereas surface 4 produced mixed results. Surfaces 2, 3, 5, and 6 yielded results that were similar to the poured concrete sidewalk and could be considered acceptable for wheelchair users. In conclusion, surfaces

Hunt PC, Boninger ML, Cooper RA, Zafonte RD, Fitzgerald SG, Schmeler MR. Demographic and socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injury. Arch Phys Med Rehabil 2004;85:1859-64. To determine if a standard of care for wheelchair provision exists within the participating centers and if there is disparity in wheelchair customizability among the study sample. Convenience sample survey. Thirteen Model Spinal Cord Injury Systems that provide comprehensive rehabilitation for people with traumatic spinal cord injury (SCI) and that are part of the national database funded through the US Department of Education. A total of 412 people with SCI who use wheelchairs over 40 hours a week. Survey information was obtained from subjects via telephone and in-person interviews and from the national database. Collected information included age, race, education, level of injury, and wheelchair funding source. Number and type (manual or power) of wheelchairs. Wheelchair customizability as defined by design features (eg, adjustable axle position, programmable controls). Ninety-seven percent of manual wheelchair users and 54% of power wheelchair users had customizable wheelchairs. No power wheelchair user received a wheelchair without programmable controls. Minorities with low socioeconomic backgrounds (low income, Medicaid/Medicare recipients, less educated) were more likely to have standard manual and standard programmable power wheelchairs. Older subjects were also more likely to have standard programmable power wheelchairs. The standard of care for manual wheelchair users with SCI is a lightweight and customizable wheelchair. The standard of care for power wheelchairs users has programmable controls. Unfortunately, socioeconomically disadvantaged people were less likely to receive customizable wheelchairs. © 2004 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine an

Chaves ES, Boninger ML, Cooper R, Fitzgerald SG, Gray DB, Cooper RA. Assessing the influence of wheelchair technology on perception of participation in spinal cord injury. Arch Phys Med Rehabil 2004;85:1854-8. Objective To investigate factors related to the wheelchair, impairment, and environment that affect perception of participation of persons with spinal cord injury (SCI) in activities performed in 3 settings: in the home, in the community, and during transportation. Design Cross-sectional study. Setting Research centers and a specialized assistive technology (AT) clinic in Pittsburgh (Pitt). Research centers and community-based rehabilitation technology suppliers in Saint Louis (SL). Participants Seventy wheelchair users with SCI. Interventions Subjects from Pitt and SL completed a written survey of AT usage in daily activities. Main outcome measures Subjects were asked 5 questions within each setting (home, community, transportation) related to their perceived reason for functional limitations. Results The wheelchair was the most commonly cited factor limiting participation, followed by physical impairment and physical environment. Twenty-one percent of subjects with paraplegia reported pain as a limiting factor for their transportation use, significantly more (P=.047) than subjects with tetraplegia (3%). A trend (P=.099) was seen toward a higher percentage of subjects with tetraplegia (tetraplegia, 7%; paraplegia, 3%) reporting lack of equipment as a limiting factor for use of transportation. Differences were also seen across sites. Conclusions The wheelchair was the most commonly cited limiting factor, followed by physical impairment and physical environment. The wheelchair is the most important mobility device used by persons with SCI and the one that users most associate with barriers. © 2004 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

Algood SD, Cooper RA, Fitzgerald SG, Cooper R, Boninger ML. Impact of a pushrim-activated power-assisted wheelchair on the metabolic demands, stroke frequency, and range of motion among subjects with tetraplegia. Arch Phys Med Rehabil 2004;85:1865-71. To determine differences in metabolic demands, stroke frequency, and upper-extremity joint range of motion (ROM) during pushrim-activated power-assisted wheelchair (PAPAW) propulsion and traditional manual wheelchair propulsion among subjects with tetraplegia. Repeated measures. A biomechanics laboratory within a Veterans Affairs medical center. Fifteen full-time manual wheelchair users who had sustained cervical-level spinal cord injuries. Participants propelled both their own manual wheelchairs and a PAPAW through 3 different resistances (slight, 10W; moderate, 12W; high, 14W) on a wheelchair dynamometer. Each propulsion trial was 3 minutes long. Primary variables that were compared between the 2 wheelchairs were participants' mean steady-state oxygen consumption, ventilation, heart rate, mean stroke frequency, and maximum upper-extremity joint ROM. When using the PAPAW, participants showed a significant (P<.05) decrease in mean oxygen consumption and ventilation throughout all trials. Mean heart rate was significantly lower when using the PAPAW for the high resistance trial. Stroke frequency was significantly lower when using the PAPAW for the slight and moderate resistances. Overall joint ROM was significantly lower when using the PAPAW. For subjects with tetraplegia, PAPAWs reduce the energy demands, stroke frequency, and overall joint ROM when compared with traditional manual wheelchair propulsion. © 2004 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

Manual wheelchair propulsion combined with other stresses to the upper extremities may result in secondary injury. Possible solutions would be to devise alternative methods of propulsion, such as a pushrim-activated, power-assist wheelchair (PAPAW). The goals of this study were to examine the usage of the PAPAW in a real world setting and to characterize the driving habits of manual wheelchair users. Feedback was also obtained regarding subjects' opinions with respect to the PAPAW: their likes and dislikes. A PAPAW was provided to subjects for 2 weeks. Usage (average and total distance traveled and velocity) was tracked for both the PAPAW and the subjects' own wheelchairs. Significant differences in usage were not seen between the personal wheelchairs or the PAPAW. As a result, weeks were combined to provide an overall examination of driving characteristics. The average distance traveled over an average day was 1,671.4 ± 314.8 m with an average velocity of 0.44 ± 0.09 m/second. This pilot study provides an idea of manual wheelchair usage in a population of individuals with spinal cord injury. The lack of significant findings between the PAPAW and the subjects' own wheelchairs may be a function of study methodology such as sample size and length of follow-up in the new wheelchair. Future studies should expand upon the pilot work completed here, strengthening the design. © 2003 RESNA.

Objective: To examine differences in the shock and vibration transmitted to an occupant of a manual wheelchair with and without suspension caster forks and with and without rear-suspension systems. Design: Repeated-measures engineering testing. Setting: Rehabilitation engineering center with a wheelchair standards test laboratory. Specimens: Six manual wheelchairs. Interventions: An American National Standards Institute/Rehabilitation Engineering and Assistive Technology Society of North America wheelchair test dummy and a Hybrid III test dummy were used to test shock and vibration transmission in wheelchairs equipped with original equipment manufacturer (OEM) caster forks and suspension caster forks. Ultralight wheelchairs, half of which had factory-equipped rear-suspension systems, were tested. Testing was conducted on a double-drum wheelchair test machine. Main Outcome Measures: Shocks were examined by using peak acceleration and the frequency at which peak acceleration occurs for the seat and footrest. Vibration was characterized by the acceleration power per octave for the seat and footrest. Results: Significant differences were found in the peak accelerations at the seat (P=.0004) and footrest (P=.0007) between the wheelchairs with the OEM caster forks and those with the suspension casters. The wheelchairs with suspension had significantly different frequencies at which the peak accelerations occurred for both the seat (P=.01) and footrest (P=.0001). The wheelchairs with suspension caster forks had a lower total power per octave than the wheelchairs with the OEM caster forks. For the footrest vibrations, significant differences were found between the types of caster forks for all octaves except those associated with frequencies more than 78.75Hz. There were significant differences for wheelchairs with and without rear suspension for total power per octave of seat vibrations in the octaves between 7.81 and 9.84Hz (P=.01) and 12.40 and 15.63Hz (P=.008). Conclusi

Objective: To measure the response of a test dummy while traversing common obstacles encountered by users of electric-powered wheelchairs (EPWs) to determine whether optimal wheelchair fit, use of seatbelts, and driving speed affect the frequency and severity of EPW tips and falls. Design: Repeated-measures comparison study. Setting: Constructed environment both in and around a Veterans Affairs medical center. Participant: A 50th percentile Hybrid II anthropometric test dummy (ATD) was used to simulate a person driving an EPW. Interventions: The ATD was driven in 4 different EPWs over commonly encountered obstacles at speeds of 1 and 2m/s, with and without the use of a seatbelt, and at varying legrest heights. Main Outcome Measures: The response and motion of the ATD were observed and recorded as no fall, loss of control (the ATD falls forward or sideways but remains in the EPW), the ATD falls out of the EPW, or the EPW tips completely. Results: A total of 97 adverse events out of 1700 trials were recorded: 88 were losses of control (instability) and 9 were ATD falls. No complete tips of any EPW occurred. Univariate statistical analysis indicated a significant relationship between the adverse events and the use of seatbelts, legrest condition, and test obstacles (P<.05). A mixed-model analysis confirmed the significant relationships between the adverse events and the use of seatbelts, legrest condition, and test obstacles (P<.05). However, the mixed model indicated that (1) there was no significant relationship between the adverse events and driving speed and (2) no one obstacle was designated to be the most problematic. Conclusion: Persons who use EPWs should use seatbelts and legrests while driving their EPWs, and clinicians should include common driving tasks when assessing the proper set-up of EPWs.

Although the exposure to whole-body vibrations (WBV) has been shown to be detrimental to seated humans, the effects of wheelchairs and seating systems on the transmission of vibration to an individual have not been thoroughly examined. The purpose of this study was to determine if the selected wheelchair seat cushions and back supports minimize the transmission of vibrations. Thirty-two wheelchair users traversed an activities of daily living course three times using 16 randomly selected seating systems as well as their own. Vibrations were measured using triaxial accelerometers at the seat and participant's head. The weighted fore-to-aft (Tx), vertical (T z), and resultant (Tr) transmissibility based on the vibrational-dose-value (VDV) were used to determine if differences existed among the four seat cushions and back supports. The obstacles that seem to have the largest effect on the transmission of WBV are the single event shocks and the repeated event shocks. Comparisons between the individuals own seating system and the tested seating systems suggest that the individuals are not using the most appropriate seating system in terms of the reduction of vibration transmission.

Whole-body vibration exposure has been found to be detrimental to the health of humans owing to effects such as degraded comfort, disc degeneration, and lower back pain. The purpose of this study was to determine if selected seat cushions and back supports minimize the transmission of vibrations during manual wheelchair propulsion. Ten unimpaired participants traversed an activities of daily living course using four seat cushions and four back supports. Vibrations were measured using triaxial accelerometers. The time domain and frequency domain transmissibility was used to determine if differences exist among seat cushions and back supports. Differences were found among the four seat cushions and four back supports. Seat cushion and back support manufacturers should concentrate on single-event shocks and repeated shocks, as opposed to oscillatory motions and self-generated vibrations, because the vibrations generated by these events tend to reside in the range of frequencies most sensitive to humans. Vibrations in this range of frequencies have the greatest effect on the transmission of whole-body vibration during manual wheelchair propulsion. Differences among the seat cushions and back supports appear to be due to the seat cushion/back support design and postural support. From a clinical perspective, the time domain transmissibility best describes the transmission of whole-body vibration. © 2003 RESNA.

Background: The INDEPENDENCE 3000 IBOT Transporter (IBOT) is an electronically stabilizing mobility device for people with disabilities. It operates in 4 functions: Standard, Balance (raised on 2 rear wheels), 4 Wheel (for inclines, curbs, and uneven terrain), and Remote (for loading into a vehicle). Objective: The purpose of this study was to observe the IBOT at use in the home and in the community. Methods: Data were obtained via observations by trained clinicians, data recorded from a computerized data logger, and reports from each expert. Participants: Participants included 10 unimpaired nonwheelchair users (6 men, 4 women) and 4 expert wheelchair users (men with spinal cord injuries, T7-L1). The participants used the IBOT to perform a variety of activities, including holding eye-level discussions with colleagues and shopping by balancing on 2 wheels, going up and down steep ramps, traversing outdoor surfaces (eg, grass, dirt trails), and climbing curbs. Observations: The Balance and 4-Wheel functions were helpful and worked well. The IBOT required attention to control in the Standard function. The seat height was too high for most tables and desks, and the IBOT was challenging to use in the bathroom. Conclusion: The IBOT is a functional mobility device that expands the options of wheelchair users. It is most useful outdoors and where there is sufficient space to use its unique Balance function.

Background/Objective: The objective of this study was to examine the use and efficacy of a pushrim-activated power-assist wheelchair (PAPAW) in the reduction of upper extremity range of motion (ROM) and stroke frequency in manual wheelchair users. Methods: Ten manual wheelchair users were evaluated using a repeated-measures design with and without the use of a PAPAW for maximum ROM of shoulder flexion/extension, abduction/adduction, internal/external rotation, and horizontal flexion/extension; elbow flexion/extension; wrist flexion/extension, supination/pronation, and ulnar/radial deviation; and stroke frequency. Participants propelled a Quickie 2 manual wheelchair configured as a PAPAW and their own wheelchair on a computer-controlled dynamometer at 3 different resistance levels and 2 different speeds. Results: The use of the PAPAW significantly (P < 0.05) decreased shoulder flexion/extension and horizontal flexion/extension, elbow flexion/extension, and wrist flexion/extension and ulnar/radial deviation for many speed and resistance combinations. Univariate analysis revealed that stroke frequency was unaltered in all cases. Conclusion: These findings provide the foundation for studying the utility of the PAPAW in reducing the risk of upper limb injury and neuropathy in the manual wheelchair user population.

Objectives: To determine the driving characteristics of electric-powered wheelchair users during unrestricted community activities and to compare the activity levels among an active group and a group of regular users. Design: Multisite engineering evaluation of electric-powered wheelchair driving activity during unrestricted community mobility. Setting: Data were collected in the communities of Pittsburgh, PA, and the National Veterans Wheelchair Games (NVWG) in San Antonio, TX. Participants: Seventeen people participated, all of whom used electric-powered wheelchairs as their primary means of mobility. Intervention: Each subject was asked standarized questions about self and wheelchair use. Data logger and sensor installed on wheelchair. Data downloaded from logger. Main Outcome Measures: Speed, distance traveled, and the time that each subject� personal wheelchair was being driven were recorded for 24hr/d over approximately 5 days for each subject by using a custom-built data logger. Results: The NVWG group traveled faster than the Pittsburgh group, but this difference was only statistically significant on the first day. The NVWG group was more likely to travel longer than the Pittsburgh group with significant differences seen in day 4 (P =. 03) and day 5 (P =. 05). Total distance traveled during the 5-day period and average distance traveled per day were also significantly different between the groups (P =. 02 for both 5-day distance and daily distance), with the NVWG group traveling longer (17, 164 ± 8708m) when compared with the Pittsburgh group (8335 ± 7074m) over the 5-day period. Both distance traveled and speed increased during afternoon and evening hours. The maximum distance traveled by any subject for each hour across the 2 groups was used to create the theoretic maximum distance day, which resulted in 7970m of driving. Conclusion: Drivers of electric-powered wheelchairs are most active during the afternoon and evening hours. Over the 5-day period of thi

For individuals with a spinal cord injury or dysfunction (SCI/D), opportunities to exercise are limited and are usually not highly motivating experiences. Exercise programs or extracurricular activities may help increase or maintain the cardiovascular fitness level of individuals with SCI/D. The GAMEWheels system, an interface between a portable roller system and a computer, enables an individual to control a video game by propelling his or her wheelchair. The purpose of this study was to investigate whether the propulsive forces used during video play, both with and without the GAMEWheels system, were different. A secondary purpose was to examine differences in metabolic parameters during exercise under these two conditions. Ten manual wheelchair users exercised on the GAMEWheels system with and without controlling a video game. Physiological and kinetic data were collected six times during two exercise trials. Kinetic data were recorded with the SMARTWheel and used to investigate propulsion forces. No significant differences were found in the resultant force, rate of rise, or number of hand contacts with the pushrims. This study showed that propulsion pattern did not change significantly when wheelchair users exercised while playing a computer video game. Oxygen consumption, ventilation, and heart rate were significantly different (p < 0.05) between the two groups during the last three exercise intervals and cooldown. Playing a video game while exercising may help to motivate manual wheelchair users to exercise longer and regularly, something that was reported by this study's subjects; likewise, exercising while playing a video game may not be associated with higher pushrim forces and stroke frequencies.

There are limited interface options for electric powered wheelchairs, which results in the inability of some individuals to drive independently. In addition, the development of new interface technologies will necessitate the development of alternative training methods. This study compares a conventional position sensing joystick to a novel isometric joystick during a driving task in a virtual environment and a real environment. The results revealed that there were few differences in task completion time and root-mean-square error (RMSE) between the two types of joysticks. There were significant correlations between the RMSE in the virtual environment and the real environment for both types of joysticks. The data indicate that performance in the virtual environment was representative of driving ability in the real environment, and the isometric joystick performed comparably to the position sensing joystick. © 2002 IPEM. Published by Elsevier Science Ltd. All rights reserved.

Objectives: To classify stroke patterns of manual wheelchair users and to determine if different patterns of propulsion lead to different biomechanics. Design: Case series. Setting: Biomechanics laboratory. Participants: Thirty-eight individuals with paraplegia who use manual wheelchairs for mobility. Intervention: Subjects propelled their own wheelchair on a dynamometer at 2 different steady state speeds. Bilateral biomechanical data were obtained by using a force and moment sensing pushrim and a motion analysis system. Main Outcome Measures: The propulsive stroke of each participant for each speed and side was classified as following 1 of 4 patterns. These 4 patterns were then compared by using a mixed-model analysis of variance. The biomechanical variables that were compared were cadence, peak and rate of rise of the resultant force, mechanical effective force, push angle, and ratio of time spent pushing to time in recovery. Results: The most common propulsive stroke involved the user lifting the hand over the pushrim during the recovery phase. The stroke pattern was independent of axle position and varied from side to side and between speeds. After controlling for subject characteristics, significant differences were observed between stroke patterns in cadence and ratio of time spent pushing to time in recovery. A stroke pattern that involves using a semicircular motion with the hand below the pushrim during the recovery phase of the propulsion stroke was associated with a lower cadence and more time spent in the push phase relative to the recovery phase. Conclusion: The semicircular motion of propulsion displayed characteristics consistent with reduced repetition and more efficient propulsion. Use of this propulsion style may reduce trauma to the upper extremities. Clinicians should consider training individuals in this propulsion style. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

Objectives: To examine 3 types of manual wheelchairs - ultralight wheelchairs (UWs), lightweight wheelchairs (LWs), and depot wheelchairs (DWs) - and to compare the fatigue life between the wheelchair types. Design: A database of different manual wheelchairs tested according to the International Organization for Standardization (ISO). Fatigue life was determined by using standards that define methods accepted internationally using double-drum and curb-drop testing equipment. Setting: A rehabilitation engineering center. Specimens: Sixty-one manual wheelchairs: 25 DWs, 22 UWs, and 14 LWs. Main Outcome Measures: Wheelchairs were examined for differences in fatigue life based on equivalent cycles. Unique survival curves were fit and compared for each wheelchair type. Results: The UWs lasted the longest, with a mean of 309,362 equivalent cycles. The DWs faired the worst, with a mean of 117,210 equivalent cycles. The Kaplan-Meier survival curves were significantly different (p<.001), with the UWs having the longest fatigue life. Conclusion: Fatigue life for UWs is significantly greater (p<.05) than LWs and DWs, indicating wheelchairs differ in durability. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

The objective of this study was to quantify the difference in mechanical efficiency and user power generation between traditional manual wheelchairs and a pushrim activated power assisted wheelchair (PAPAW). Ten manual wheelchair users were evaluated in a repeated measures design trial with and without the PAPAW for propulsion efficiency. Subjects propelled a Quickie GP equipped with the PAPAW and their own chair on a computer controlled wheelchair dynamometer at five different resistance levels. Power output, user power with the PAPAW hubs, subjects' oxygen consumption per minute and mechanical efficiency were analyzed. Metabolic energy and user power were significantly lower (p<0.05), and mechanical efficiency significantly higher with the PAPAW than with subjects' own chairs. Subjects needed to generate on average 3.65 times more power when propelling their own wheelchairs as compared to PAPAW. Mean mechanical efficiency over all trials was 80.33% higher with the power assisted hubs. PAPAW provides on average 73% of the total power when subjects propel with power assistance. Significantly increased efficiency and reduced requirement of user power is achieved using the PAPAW. With use, the PAPAW may contribute to delaying secondary injuries of manual wheelchair users. In addition, it may be suitable for people who have (or at risk for) upper extremity joint degeneration, reduced exercise capacity, low strength or endurance who currently use electric powered wheelchairs.

GAMEWheels is an interface between a portable roller system and a computer that enables a wheelchair user to play commercially available computer video games. The subject controls the game play with the propulsion of their wheelchair's wheels on the rollers. The purpose of this study was to investigate whether using the GAMEWheels System during wheelchair propulsion exercise can help increase the individual's physiological response and aid in the motivation to exercise. Fifteen subjects participated in this study. The subjects propelled their wheelchairs on a portable roller that was equipped with the GAMEWheels System. There were two exercise trials consisting of 2 min of warm-up, 16 min of exercise and 2 min of cool-down. Physiological data (ventilation rate, oxygen consumption, heart rate) were collected. A significant difference (P<0.05) was found between exercise with GAMEWheels versus without GAMEWheels for average ventilation rate and average oxygen consumption. The differences were found during time periods of transition from warm-up to exercise, and before and after the midpoint of exercise. Written questionnaires showed that 87% of the individuals tested reported the system would help them work out on a regular basis. Playing the video game helped these individuals to reach their exercise training zone faster and maintain it for the entire exercise trial.